Patient characteristics and the safety of stent placement for malignant vena cava syndrome in Japan: a nationwide analysis.

PURPOSE: To evaluate the overall safety of stent placement for malignant superior or inferior vena cava (SVC/IVC) syndrome by assessing adverse events in a nationwide multicenter population.

METHODS

We conducted a retrospective cohort study using the Japanese Diagnosis Procedure Combination nationwide inpatient database. Patients who underwent stent placement for malignant superior or inferior vena cava (SVC/IVC) syndrome between April 2019 and March 2023 were included. The primary endpoint was the overall incidence of adverse events, which were identified using International Classification of Diseases, 10th Revision codes. Secondary evaluations included patient characteristics, underlying malignancies, therapeutic interventions, 7-day mortality after stent placement, 30-day in-hospital mortality after admission, and comparisons between the SVC and IVC groups.

RESULTS

This nationwide study included 301 patients from 137 hospitals, of whom 187 underwent SVC stenting, and 114 underwent IVC stenting. Overall, 34 adverse events occurred in 32 patients (10.6%). Red blood cell transfusion was required in 10 patients (3.3%), but no invasive treatment, including embolization, was required. Seven-day mortality after stenting was 5.0%, and 30-day in-hospital mortality after admission was 11.6%. In comparisons between the SVC and IVC groups, respiratory failure was more common after SVC stenting, whereas other adverse events and mortality were comparable between groups. Lung tumors predominated in SVC cases and liver tumors in IVC cases; multiple stents were used more frequently in IVC cases.

CONCLUSION

Stent placement for malignant vena cava obstruction demonstrated an overall complication rate of 10.6% with no serious adverse events requiring invasive intervention.